Many patients write to us asking whether to see a neurologist or orthopedist for herniated discs. This is an excellent question, to be sure, and my experiences over the years have changed my opinion as to the ideal answer.
Both doctors are physicians, either an M.D. or a D.O., and both are considered specialists for purposes of insurance and expert opinion. However, the insights provided by both types of doctors may vary greatly, as will the treatment recommended in many cases.
The scope of this article will provide some information about both types of care providers and what to expect if you consult with either one regarding a herniated spinal disc diagnosis.
Orthopedists are doctors who specialize in the skeletal system. Basically, they concentrate on bones. The spine is surely made up of vertebral bones, but also a great variety of soft tissue and nerve tissues.
Many orthopedists are general orthopedic practitioners, meaning they handle all manner of bone issues ranging from broken fingers to heel spurs to spinal disorders. If you are going to see an orthopedist, I highly recommend finding one who is a spinal specialist. Save the general orthopedist for your kid’s broken arm.
In my experience, I found virtually every orthopedist to really focus on a variety of spinal issues which have been deemed through research science to be coincidental to the occurrence of back and neck pain. These issues included the universal degenerative disc disease and, of course, herniations.
Many orthopedists are incredibly structurally-obsessed and most will blame disc issues for causing pain in virtually every case. Ironically, discs themselves do not feel pain and only elicit pain through neurological interactions. This is one of the reasons I tend to recommend seeing a neurologist instead.
As far as treatment goes, this depends greatly on the ideology and practice of the doctor in question. Some conservative orthopedists will go with conservative modalities, such as physical therapy. It is no surprise that physical therapists and orthopedic physicians work very closely together.
Doctors who are orthopedic surgeons will often recommend surgery, which can become a very treacherous path for any patient to follow.
Neurologists also come in many areas of focus with spinal and brain experts being at the top of the medical hierarchy. Always seek out a spinal neurologist whenever possible for best results.
Herniated discs are theorized to cause pain through one of several possible methods, but every single one of these possibilities involves nerve tissue. Therefore, the neurologist may be the better choice for care. Neurologists are far better qualified to correlate structural findings with exact symptomatic expression, decreasing the chance for misdiagnosis compared to other types of doctors.
Additionally, I find neurosurgeons to be far more cautious in their recommendations to undergo surgical intervention than orthopedic surgeons. This is always an advantage, since herniated disc surgery should always be a last resort option.
In general, I advise patients see a neurologist for disc-related back and neck pain concerns. Even many skeletal issues implicated in causing dorsopathy only do so due to nerve involvement. So this is an (almost) absolute piece of advice.
I have seen many orthopedists and a few neurologists and have recently found a good neurologist who is actually quite open to the mindbody explanation of pain. I do have some very serious structural issues in my spine which require monitoring and therefore I continue bi-yearly consultations. I do not undergo treatment, but if the time comes that I do need professional therapy, I am quite sure I would rather trust myself to a neurologist than any other type of doctor.
Of course, any type of physician can be wonderful and any type can be greedy and opportunistic. Always take into account the personality and motivation of any doctor you see. If you get the impression that you are only valuable to them as a source of income, rather than as a human being, go elsewhere. This is a good piece of advice for all personal and business interactions in life.